Faricimab versus the standard of care for neovascular age-related macular degeneration in Italy: an indirect treatment comparison

Objectives: To assess through an indirect treatment comparison (ITC) the potential benefit of faricimab over the anti-vascular endothelial growth factor (VEGF) real-life scenario, hereby defined standard of care (SoC), in Italy, that is, aflibercept, bevacizumab, and ranibizumab, in patients with neovascular age-related macular degenera- tion (nAMD) naïve to any anti-VEGF treatment. Methods: Individual patient-level data from the phase III clinical trials TENAYA and LUCERNE (faricimab cohort) and the real-world study RADIANCE (RADIANCE cohort) were used. Efficacy was evaluated with changes in best corrected visual acuity (BCVA) and central subfield thickness (CST) from baseline to 1 year (week 52 in the RADIANCE and week 48 in the faricimab cohorts, respectively). Propensity score-based inverse probability of treatment weighting was utilized to balance cohorts and mitigate bias due to potential confounding. Sensitivity analyses were performed to evaluate treatment differences adjusted for the number of injections. Results: The ITC included 513 patients treated with faricimab and 263 patients treated with SoC. At 1 year, farici- mab showed a greater mean BCVA gain (treatment difference +5.4 letters, p<0.001) and CST reduction (treatment difference −71.8 μm, p<0.001) compared to SoC. Sensitivity analyses confirmed the robustness of results, show- ing a BCVA improvement of +4.0 letters and a CST reduction of −71.5 μm in favor of faricimab. Conclusions: Despite the limitations due to the use of ITC and the comparison between clinical trials and real- world cohorts, the present analysis suggests potential benefits in terms of vision gain and CST reduction in naïve nAMD patients treated with faricimab compared with SoC in a real-world setting.